Pandemic halts progress of family planning initiatives

Birth rates could rise amid pandemic

• Total fertility rate in Bangladesh brought down to 2.05 in 2018
• Target set before pandemic to bring it down to 2.0 by 2021
• Rural women now have total fertility rate of 2.38
• Women in urban areas or city centres have fertility rate of 1.68
• Worry over spread of Covid-19 has deterred healthcare givers
• Many field-level staff caught Covid-19 trying to provide services

In the pre-pandemic days, Mohammad Jahed Ali used to arrange group counselling sessions on family planning and nutritional needs during pregnancy to couples in Basudebpur union under Godagari upazila, Rajshahi.

He has been advising the 30,000 people in this remote area since joining as a union family planning inspector seven years ago.

"We have counselled women who married before the age of 18 to not conceive before they reach 20. We explained to them why it is important for the health of them and their new-borns," Jahed said.

More than 30 percent of the 5,000 women, aged 15 to 49, in the union have more than three children.

Now Jahed finds his job difficult as villagers no longer welcome visitors like him. Nor are they willing to come to the mother and child care centres for family planning services. However, his services are badly needed in Rajshahi where adolescent pregnancy is the highest, followed by that in Rangpur.

Four months into the coronavirus pandemic, sessions on reproductive healthcare remain mostly inaccessible, just like education, in a country where economic wounds run deep.

Men and women in almost every household are losing jobs and incomes to the pandemic that has shuttered several businesses. Youths who were about to step into the labour force find a steep descent ahead of them; the much-talked-about demographic dividends from a large working-age population now seem to be illusive, with young migrants returning from abroad and cities in hundreds of thousands to their village homes.

Caught in the chaos, families will likely be least bothered about the reproductive healthcare.

A matter of great concern now is the sudden rise in childbirths because both poverty and a lack of education play a vital role in the population growth.

That would jeopardise the nation's progress in children's and adolescents' healthcare, pushing up both the child and maternal mortality rates. It took decades to achieve these development goals.

Though there are many challenges yet to be overcome, such as child marriage, the government successfully brought down the total fertility rate – the number of children born per woman – to 2.05 in 2018, according to the Bangladesh Bureau of Statistics.

Four years ago, the rate was 2.11. Before the pandemic, the target had been set to bring it further down to 2.0 by 2021.

But this will be hard to attain when couples dread coming to healthcare centres for family planning services. Field-level workers, fearing infection, have also stopped going from door to door to motivate new couples. And adolescent mothers are at high risk of becoming pregnant due to a lack of counselling.

Rural women between 15 and 49 years of age, with a total fertility rate of 2.38, tend to have more children than urban areas or city centres, where the fertility rate is 1.68. Also, regions scourged by poverty and illiteracy have been the hubs of higher child marriage and higher adolescent pregnancy rates.

Reproductive healthcare is even harder to get for people who are cut off from the road network or who are marooned, with water all around, like in the haor areas of Sunamganj district.

People there travel by boat. Worry over the spread of Covid-19 has further deterred healthcare givers from giving services, said Dr Kamrul Hasan, upazila health and family planning officer of the Shalla Upazila Health Complex in Sunamganj. 

"Many mothers will fail to get antenatal care now, which might lead to increased maternal and child mortality," said Prof Dr Mohammad Mainul Islam, chairman of the Population Science Department of Dhaka University.

In many areas, however, field-level workers talk to the already registered mothers over the phone and advise them or deliver any products they ask for.

But the products are not always available.

Dr Joynal Haque, programme manager of the Directorate General of Family Planning, said the distribution of family planning materials has been hampered by the pandemic.

Moreover, there has been no training of the staff for a while. "We are now thinking of organising online training sessions on a limited scale."

Many initiatives have remained suspended, which "might slow us down in reaching the target," Joynal added. 

But according to Professor Mainul, the solution lies in taking up new strategies, particularly customised for marginalised and more vulnerable groups. 

"Region-based planning might be one way to address the limitations. Besides, the system to provide family planning services needs to be reviewed," Mainul added.

In the meantime, many field-level staff got infected with the novel coronavirus while trying to provide services to the doorstep. 

Vacant posts and infections 

Mohammad Makin, family planning office of Mohanpur upazila in Rajshahi, said on Wednesday that he had been suspected of having contracted the virus. One paramedic had recently tested positive and many others had Covid-19 symptoms.

"We had already been working with limited manpower. Fourteen of the 35 posts for field-level staff have been vacant for four to five years. The coronavirus has worsened the situation."

Those who have not become sick yet avoid visiting people at home, Makin added.

AKM Rezaul Karim, family planning officer of Mithapukur upazila in Rangpur, has stumbled across similar challenges.

People of the area, where designated staff are absent either for vacant posts or coronavirus infections, do not always get access to the services, he said.

"Child marriage is still prevalent and adolescent women are more likely to conceive frequently," he said, adding that focus on them might help contain adolescent pregnancy around this time.

Paramedics, midwifes and counsellors who work within the communities should be assured of safety when they have to strive to continue providing reproductive healthcare, he suggested.

"We need personal protective equipment, masks, gloves and hand sanitisers so we can work abiding by the health safety guidelines," said Akhtaruzzaman, who works in Ranipur union of Rangpur.

The Directorate General of Family Planning acknowledges that population growth, which has been static at 1.37 percent for at least six years, is "one of the most important problems of the nation," and so is the major cause of poverty.

A grim future might be looking at the nation but it can get off the path and on its track to the target, with prompt measures.